17 February 2009

On Birth - When Does Labor Begin?

The question of when labor begins is not easy to answer, even though it may sound simple. In observing labor as a phenomenon in itself, I see labor as being a non-discrete occurrence that actually begins with conception & gradually leads to the birth of the baby.
What most people call labor is actually just a special part of the process. It would be as if one said that making love consisted of only the moments of orgasm, when the actual process of making love may have begun even months before with a flirtatious glance, and gradually built up on physical, emotional, & spiritual levels over the whole time, culminating in the physical embraces & orgasm itself. What happens before the orgasm is not necessarily not making love & the orgasm is not necessarily the end or the goal or product of the process. If one makes love & no orgasm occurs it does not mean it was not making love.
Likewise, labor is building up throughout pregnancy. In the latter part of pregnancy there are often several flirtatious episodes of what could lead up to the orgasm of birthing, yet often they subside. Those "signs of impending labor" may come & go several times in the weeks before birthing.
So does the labor start when the impending signs start? In this case many of the women I assist have been in labor for weeks. Before I became more spacious in my definition of the beginning of labor I believed & treated these women as though they were in labor - and often ended up pushing their labors by various means including transporting them to the hospital for exhaustion & "lack of progress".
I believe even the classic definition of labor - there is a progressive change in the effacement, dilation of the cervix & the baby moves lower - is not a sign that the woman is ready to give birth soon. Most midwives who do vaginal exams near term notice that some women become quite dilated in the weeks before they have the baby all the way out - up to 4 centimeters. A woman who is having impending signs, having some mild contractions, goes to the doctor or midwife to get checked will be told that she is in labor. Then the labor of labor begins because when everyone believes she is in labor & she believes she is in labor, that is when it actually begins. And if she was actually still in a flirtatious stage rather than the culminating stage she may be pushed & dragged through labor by breaking her amniotic bag, drugs, & mechanical assistance or c-section.
So I see the definition of the beginning of labor as being very important to how we educate women about labor & how we assist women in the process of giving birth. Currently I teach women to ignore contractions as long as possible, warning them that they may start & stop many times in the last weeks of pregnancy & that's just fine - preparation. This works well for them. We also do not treat women as though they are in labor until they are well established in a strong labor pattern, encouraging them to ignore it until they can't and then spending time alone with their mate in a pleasant environment until they both decide it's time for us to come. We educate them about delivering the baby themselves, discussing it a lot to allow them to feel as comfortable as possible being alone for as much of the labor as possible. This allows for the least interference possible with the natural laboring process and fewer transports for lack of progress.

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